Among socio-economically disadvantaged minority and white women, depression during pregnancy and the postpartum is often under-detected and under-treated. Maternal postpartum depression has adverse, lasting effects on maternal, infant and child well-being. Depression during pregnancy has been demonstrated to be the most potent predictor of postpartum depression and appears to be linked to low birth weight and prematurity. Poor, urban women are at least twice as likely as middle-class women to meet diagnostic criteria for major depression during pregnancy. At the same time, depressed, disadvantaged women have been proven difficult to engage and retain in mental health treatment because they face numerous barriers to care at the patient, provider, and system levels. This proposed randomized, controlled trial will evaluate the effects of a culturally relevant, multicomponent intervention for antenatal depression (FOR MOMS, "Maintain Our Mothers'Strength") that has the potential to overcome patient, provider, and system-level barriers to care and engage depressed, low-income women in evidence-based treatments to reduce antenatal depressive symptoms, improve maternal psychosocial functioning, and ameliorate postpartum depression. This research will take advantage of the unique partnership between the Seattle King County Public Health Department (PHSKC) and the University of Washington's School of Social Work and Department of Psychiatry. We propose to enroll a sample of 220 depressed, pregnant women on Medicaid from PHSKC and will test the effectiveness of the FOR MOMS intervention relative to usual care for antenatal depression. FOR MOMS consists of a pre- treatment engagement session and a choice of brief interpersonal psychotherapy (IPT) or evidence-based pharmacotherapy. The engagement session and brief IPT for antenatal depression have been enhanced to reduce racial and economic disparities in treatment engagement and retention and have been shown to be effective in a pilot study. After study entry, assessments will be conducted at baseline and 3, 6, 12, and 18 months post-baseline, a time period designed to include the first postpartum year. We will examine the effects of the FOR MOMS intervention on clinical and functional outcomes and conduct an incremental cost effectiveness analysis of the costs and benefits of the intervention from a health and welfare agency perspective. Our study team is comprised of an interdisciplinary group of researchers with extensive expertise in health services research, health economics, and clinical research with depressed, low-income, minority women. Performance Sites: Seattle King County Public Health Department, Seattle, WA University of Washington, Seattle WA This proposed randomized, controlled trial will evaluate the effects of a culturally relevant, multicomponent intervention for antenatal depression (FOR MOMS, "Maintain Our Mothers'Strength") that has the potential to improve maternal and child health and mental health by reducing antenatal depressive symptoms, enhancing maternal psychosocial functioning, and ameliorating postpartum depression.